Client Intake Form New Client Intake Form Basic Information Name * Name First First Last Last Email * Social Media Handle Date of Birth * Height (ft) * 4567 Height (in) * 01234567891011 in Height (cm) * cm Weight * lbs Weight (kg) * kg Units * Imperial Metric Gender * Please selectMaleFemaleTransgenderNon-Binary/Non-ConformingPrefer not to state Which coach will you be working with? * Please choose oneNot sure yetAdam FetterAndrew SimmerlingAnthony MihelichBrianna LambDominic ScalzoKeith DeNinnoMarcus FillyRyan RiveraShanna Guzman Goals & Training History What are your goals for starting this program? * Get stronger Lose fat Gain muscle mass Longevity Lower stress/improve mental health Fun and enjoyment Compete in CrossFit or another sport Better endurance Skill development Learn more about training Overcome/prevent injury Personal growth Improve overall health Be more consistent with training and/or nutrition Set a good example for others OtherOther Select all that apply What are your biggest goals in life? * What are your current obstacles in attaining the health and fitness you desire? * How long have you done resistance training? * < 1 year 1-2 years 3-5 years 5+ years Which programs have you followed in the past? * CrossFit Powerlifting Bodybuilding or body part splits Functional Bodybuilding Other group class (Orange Theory, F45, etc) Weight training for a sport General globo gym training on machines & free weights OtherOther Select all that apply Do you have any injuries or medical issues? * Lifestyle & Nutrition How many hours per week do you spend recovering and recharging? * 0 What do you do for recovery activities? * Nothing Sauna Cold Plunge Stretching Physical Therapy Massage Chiropractic Work Meditation Active recovery (gentle walk/bike/swim etc.) Reading/drawing/journaling OtherOther What's your typical stress level? * 1 2 3 4 5 1 = Least stressed, 5 = Most How is your energy overall? * 1 Star 2 Stars 3 Stars 4 Stars 5 Stars 1 Star = Lowest Rate your sleep quality and duration. * 1 Star 2 Stars 3 Stars 4 Stars 5 Stars 1 = Poorest Please describe your relationship to food. * Which best describes how much food you prepare for yourself each week? * None - I eat out, eat pre-made food, or someone else cooks in my household I cook less than a third of my own meals I cook 1/3 to 1/2 of my own meals I cook 1/2 - 2/3 of my own meals I cook most if not all of my meals from scratch Overall happiness/contentment in life 1 Star 2 Stars 3 Stars 4 Stars 5 Stars Anything else you'd like to share with your coach? If you are human, leave this field blank. Finish & Submit
